The main paper´s target has been the pneumonias clinical course, the diagnostics, and the medical treatment peculiarities and the special features study and the examination, having developed against the background of the acute virus and the respiratory diseases (AVRD) epidemical attack in the spring.
Materials and methods
The pneumonias development, the diagnostics, the clinical course and the medical treatment peculiarities and the special features at the persons of the young age at the AVRD seasonal epidemical attack, having been before their illness in the organized community have already been analyzed. This analysis has been carried out at the 160 men at the age of from 18 up to 24 years (where 20,4 years have been the average age), having accepted into the pulmonological department therapeutics clinic of the Saratov Military Medical Institute.
The sick people have been accepted with the «community - acquired pneumonia» preliminary diagnosis from the pre - admission stage, sometimes it has been very difficult for the duty doctor to make the necessary differentiation and to diversify the AVRD from the pneumonia against the AVRD background. The main reasons for the hospitalization into the pulmonological department, but not into the infectious one have been served the following criteria: the discomfort or the pains presence in the chest at the breathing, the physical data asymmetry at the chest examination, and the instrumental - laboratory characteristics.
Results and discussion
The sick people have been entering on the 2-nd - 7-th day just from the invasion disease. The non - difficult pneumonia clinical course has already been fixed it up at the 73% patients. The 12% sick people with the difficult clinical course have been lying in the resuscitation and in the intensive therapeutics department from 24 hours up to 480 hours (e.g. from 1 day up to 20 days). The double - sided inflammatory process has been at the 14% sick people.
The bacterial and the virus pneumonias clinical course analysis has been revealed the following regulations: the sick people high per cent with the hectic fever and the febrile fever (e.g. 68%), the fever large prolongation, in spite of the intensive the therapeutics. The 2 - 3 temperature rise waves have already been registered at the 1/3 sick people, and on the average, the days quantity with the temperature rise have been in 2,3 times more, than at the usual pneumonias. So, it has been succeeded in to be fixed it up the disease viral phase by the instrumental - laboratory changes at the 42 patients, having entered within the early time limits from the disease invasion. Thus, the leukocytosis has been made up in the range from 4x109 up to10x109; the relating to the stab shift has been absent, the (ESR) has not been exceeded 15-20 mm/hour. The lung pattern strengthening has been registered at the digital photofluorogram. Then, the expressed inflammatory changes have been appeared in the complete blood count (СBС), the considerable fibrinogen rise, having had its maximum up to 7,7 g./l. at the bacterial stage growth. The fine and the clear infiltration has been begun to be exposed by the X - ray method. The acute respiratory compromise has been fixed it up at the 8,4% sick people, the further complications in the form of the toxic - infectious nephropathy - at the 27% ones; the myocarditis - at the both patients; the toxic hepatopathy - at the both patients.
The antibacterial therapeutics has been carried out since the first presence day in the hospital. The penicillinic series antibiotics, the III - rd and even the IV - th generations cephalosporins, the erythromycin group antibiotics, the fluoroquinolones have already been used. The 8% sick people have been received the both antibiotics, at the same moment. The antibiotic change has been carried out - at the 6% sick people.
Thus, the early pneumonias development has been the main peculiarity and the specific feature of the spring epidemic attack of the respiratory viral infections in this year. These kinds of pneumonias have been arisen at the sick people part on the 2 - nd - З - rd disease day against the AVRD (e.g. influenza) clinic background. So, it is very difficult to be diagnosed the initial pneumonia under all these conditions. The duration and the fever clinical course variable surge rate have been conditioned by the disease viral constituent presence. The antibacterial therapeutics has been exceeded the common standards on the terms at the patients half.
The paper has been presented for the «Practising Doctor» Scientific International Conference, Italy (Rome, Florence), September 6-13, 2009. Came to the editorial office on 23.06.2009.